Individual
DOROTHY LORRAINE SHACKLEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3963 HARTLAKE ST, WOODBRIDGE, VA 22192-7477
(703) 590-2019
Mailing address
68 SOUTH SERVICE ROAD, SUITE 350, MELVILLE, NY 11545-2358
(516) 945-3000
(516) 945-3131
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0001212718
VA
367500000X
Certified Registered Nurse Anesthetist
598148
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003888447
—
VA
01
—
P01179302
RAILROAD MEDICARE
VA
Enumeration date
02/01/2006
Last updated
04/23/2015
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